Git4 inflammatory bowel diseases

DR S C GAN FMHS/UTAR 09102012 1

GIT4: Inflammatory Bowel GIT4: Inflammatory Bowel DiseasesDiseasesDR GAN SENG CHIEWDR GAN SENG CHIEWAssociate ProfessorAssociate Professor

Faculty of Medicine & Health SciencesUniversity Tunku Abdul Rahman

2DR S C GAN FMHS/UTAR 09102012


Digestive Diseases • Stomach Diseases include non-cancerous disorders and

gastric malignancies.• Non-cancerous conditions we include peptic ulcers, acid

hypersecretory conditions such as Zollinger-Ellison syndrome, and gastrointestinal bleeding. Stomach cancer, also called gastric cancer or malignancies, may include cancer of the upper part of the stomach where it meets the esophagus, and is called gastric cardia cancer. Stomach cancer that occurs in the lower stomach is called non-cardia gastric cancer.

• Anorectal Diseases ; Celiac Disease ; Colorectal Cancer;

Esophageal Diseases ; Functional Dyspepsia; Inflammatory Bowel Disease (IBD): Ulcerative Colitis, Crohn's Disease &

Irritable Bowel Syndrome.

Watermelon stomach • Characterized by the

presence of blood vessel lesions in the lower part of the stomach, called the antrum. These vessels are twisted and dilated and radiate outward from the pylorus .

• The lesions resemble the dark stripes on the surface of a watermelon .

Symptoms may include sudden (acute) hemorrhage, chronic occult bleeding, and anemia.


Abdominal Migraine

• Abdominal migraine is one of the variants of migraine headache. It is also known by other terms including "periodic syndrome." This variant most typically occurs in children. They usually have a family history of migraine and go on to develop typical migraine later in their life.

• The attacks are characterized by periodic bouts of moderate to severe midline abdominal pain lasting for 1-72 hours. Along with the abdominal pain they may have other symptoms such as nausea and vomiting, flushing or pallor. Tests fail to reveal a gastro-intestinal cause for the pain. Medications that are useful for treating migraine work to control these attacks in most children including daily preventive medications and anti-nausea medications to take during the attack.


Dumping syndrome• Dumping syndrome is a group of symptoms developed after

surgery to remove all or part of your stomach, or the stomach has been surgically bypassed to help lose weight. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of the stomach are transported or "dumped" into the small intestine too rapidly. Common symptoms include abdominal cramps and nausea.

• In dumping syndrome, food and gastric juices from your stomach move to your small intestine in an unregulated, abnormally fast manner.

• Dumping syndrome often improves on its own without medical treatment or after adjusting the diet. In more-serious cases of dumping syndrome, medication or surgery may be needed.

• Some experienced low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Insulin influences your tissues to take up the sugar present in your bloodstream.



Gas in the Digestive Tract

• Everyone has gas in the digestive tract.• Gas comes from two main sources: swallowed air and

normal breakdown of certain foods by harmless bacteria naturally present in the large intestine.

• Many foods with carbohydrates can cause gas. Fats and proteins cause little gas.

• Foods that may cause gas include beans, vegetables, such as broccoli, cabbage, brussels sprouts, onions, artichokes, and asparagus; fruits, such as pears, apples, and peaches; whole grains, such as whole wheat and bran; soft drinks and fruit drinks; milk and milk products, such as cheese and ice cream, and packaged foods prepared with lactose, such as bread, cereal, and salad dressing; foods containing sorbitol, such as dietetic foods and sugar-free candies and gums

• The most common symptoms of gas are belching, flatulence, bloating, and abdominal pain. However, some of these symptoms may be caused by an intestinal disorder, such as IBS, rather than too much gas.• The most common ways to reduce the discomfort of gas are changing one’s diet, taking digestive enzymes to help digest carbohydrates, and reducing the amount of air swallowed.• Everyone has gas and eliminates it by burping or passing it through the rectum. However, many people think they have too much gas when they really have normal amounts. Most people produce about 1 to 4 pints a day and pass gas about 14 times a day.


Gastroparesis • Gastroparesis, also called delayed gastric emptying, is a disorder in

which the stomach takes too long to empty its contents. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.

• The most common cause of gastroparesis is diabetes; high blood glucose can damage the vagus nerve.

• Many people have what is called idiopathic gastroparesis, meaning the cause is unknown and cannot be found even after medical tests.

• Symptoms of gastroparesis include early fullness, abdominal pain, stomach spasms, heartburn, nausea, vomiting, bloating, gastroesophageal reflux, lack of appetite, and weight loss.

• Eating solid foods, high-fiber foods such as raw fruits and vegetables, fatty foods, or drinks high in fat or carbonation may contribute to these symptoms.

• Gastroparesis is diagnosed with tests such as x rays, manometry, and gastric emptying scans.

• Treatment includes dietary changes, oral medications, adjustments in insulin injections for people with diabetes, a jejunostomy tube, parenteral nutrition, gastric neurostimulators, or botulinum toxin.


Ménétrier Disease • Ménétrier disease causes the ridges along the inside of the stomach

wall—called rugae—to enlarge, forming giant folds in the lining of the stomach.

• Ménétrier disease is rare and more common in men, usually appearing between the ages of 30 and 60.

• Recent studies suggest people with Ménétrier disease have stomachs that make abnormally high amounts of transforming growth factor alpha (TGF-α)—a protein that tells cells what to do.

• Ménétrier disease is diagnosed through x rays, endoscopy, and biopsy of stomach tissue.

• Treatment for Ménétrier disease may include medications to relieve nausea and pain and surgery to remove part or all of the stomach.

• Other conditions that can cause enlarged rugae but are not Ménétrier disease include

Zollinger-Ellison syndrome—a condition in which tumors in the pancreas cause the stomach to make too much acid syphilis—a type of sexually transmitted bacterial infection cytomegalovirus—a type of viral infection histoplasmosis—a type of fungal infection linitis plastica—a type of gastric cancer gastric lymphoma—a type of cancer originating in the stomach


Motil i ty Disorders of the Stomach

• Examples of stomach (gastric) motility disorders include delayed gastric emptying (gastroparesis), rapid gastric emptying (dumping syndrome), and functional dyspepsia.

• For each area of the GI tract, there are different GI motility tests that assess different functions. Gastrointestinal motility testing provides physicians with important information for patient care including:

i. Correct diagnosis of GI motility disorders,

ii. A guide for treatment of patients, and

iii. Prognostic information of the patient.• Sources :

Bruce A. Orkin, MD. Physiological Testing of the Colon, Rectum and Anus. IFFGD Fact Sheet No. 111; 1993.

Henry Parkmann, MD. "On-Tract: Topics in Gut Motility," Digestive Health Matters. Vol 14 No 4; 2005.


Stomach noise • Stomach noise — such as rumbling, gurgling and growling — typically

is due to normal digestion. Stomach growling can occur when hungry. But it can also occur after eating or between meals when food is passing through the intestines.

• Hunger and appetite are controlled by a complex system of hormone-like substances primarily made by the digestive system. When the body has not eaten for a while, these substances are released and cause the hypothalamus to "switch on" the desire to eat. A message is then sent to the stomach and intestines. This triggers muscle contractions and the release of acids and other digestive fluids — which causes the rumbling, grumbling sounds you hear — as the body prepares to eat. The thought, sight or smell of food also can trigger this response.

• Sometimes excessive stomach noise can be a symptom of an underlying gastrointestinal disorder, such as irritable bowel syndrome. But in such cases, stomach noise usually is accompanied by other signs and symptoms such as bloating, cramping, diarrhea or excess gas.


Stomach polyps • Stomach polyps are masses of cells that form on the inside

lining of your stomach. • Stomach polyps usually don't cause symptoms. However, as a

stomach polyp enlarges, ulcers may develop on its surface, or rarely, the polyp may block the opening between your stomach and your small intestine.

• Stomach polyps form in response to inflammation or other damage to the lining of the stomach.

• The most common types of stomach polyps are: i. Hyperplastic polyps form as a reaction to chronic

inflammation in the cells that line the inside of the stomach. ii. Fundic gland polyps form from the glandular cells that are

found on the inside lining of the stomach. iii. Adenomas form from the glandular cells found on the

inside lining of the stomach. But when adenomas form, their cells develop errors in their DNA. These changes make the cells vulnerable to becoming cancerous.


• Factors that increase your chances of developing stomach polyps are: i. Increasing age. ii. Bacterial stomach infection. iii. An inherited colon cancer syndrome.

• Tests and procedures used to diagnose stomach polyps include: i. Using a scope to see inside your stomach. ii. Removing a sample of tissue for testing (biopsy).

• Treatment may not be necessary Small polyps that aren't adenomas may not require treatment. These polyps typically don't cause signs and symptoms and only rarely become cancerous. i. Removing adenomas and large stomach polyps ii. Stopping H. pylori infection to treat and prevent polyps


The Dangers of Aspirin & NSAIDS

• The second major cause for ulcers is irritation of the stomach arising from regular use of non-steroidal anti-inflammatory drugs, or NSAIDs.

• What are the Complications of Ulcers?

Bleeding: Internal bleeding in the stomach or the duodenum. Perforation: When ulcers are left untreated, digestive juices and stomach acid can literally eat a hole in the intestinal lining, a serious medical problem that requires hospitalization, and often surgery.

Obstruction: Swelling and scarring from an ulcer may close the outlet of the stomach, preventing food to pass and causing vomiting and weight loss.

• Conventional treatments for ulcers (classes of prescription ulcer drugs called H2 blockers and proton pump inhibitors), have been found to have a beneficial effect in treating NSAID-induced ulcers and in preventing GI bleeding.


Abdominal Pain Symptoms Symptoms that occur with abdominal pain

include:Back pain Chest pain

Constipation Coughing Diarrhea

Difficulty breathing Fever Nausea

Pain during urination Urinary frequency Vaginal bleeding Vaginal discharge

Vomiting16DR S C GAN FMHS/UTAR 09102012

Locations of the pain

• Pain may be generalized or occur all over the abdomen

• Pain may be localized to one area of the abdomen:

Left lower abdominal pain

Left upper abdominal pain

Right lower abdominal pain

Right upper abdominal pain • Pain may be in the upper middle abdomen


Some important characteristics of abdominal

pain Pain is continuous

Pain comes and goes

Pain is cramping

Pain is sharp or stabbing

Pain travels to your back, flank, or groin

Pain worsens with movement

Pain seems unrelated to movement

Pain is relieved by a bowel movement

Pain is relieved by antacids

Pain is relieved by urinating


Health & Medicine

Git4 inflammatory bowel diseases